<form id="add-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('分账接收方类型')}:</label>
        <div class="col-xs-12 col-sm-8">
            <select  id="c-type" class="form-control selectpicker" name="row[type]">
                {foreach name="typeList" item="vo"}
                <option value="{$key}" {in name="key" value="page"}selected{/in}>{$vo}</option>
                {/foreach}
            </select>
        </div>
    </div>

    <div class="form-group">
        <label for="account" class="control-label col-xs-12 col-sm-2">{:__('分账接收方账号')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input type="text" class="form-control" id="account" name="row[account]" value="" data-rule="required" />
            <strong style="color: red">分账接收方类型是商户，是mch_id，分账接收方类型是个人时，是openid</strong>
        </div>
    </div>
    <div class="form-group">
        <label for="account" class="control-label col-xs-12 col-sm-2">{:__('分账接收方全称')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input type="text" class="form-control" id="full_name" name="row[full_name]" value="" />
            <strong style="color: red">分账接收方类型是商户，商户全称（必传），分账接收方类型是个人时，是个人姓名（选传）</strong>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('参与分账')}:</label>
        <div class="col-xs-12 col-sm-8">
            <select  id="c-state" class="form-control selectpicker" name="row[state]">
                {foreach name="stateList" item="vo"}
                <option value="{$key}" {in name="key" value="page"}selected{/in}>{$vo}</option>
                {/foreach}
            </select>
        </div>
    </div>
    <div class="form-group">
        <label for="name" class="control-label col-xs-12 col-sm-2">{:__('联系姓名')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input type="text" class="form-control" id="name" name="row[name]" value="" data-rule="required" />
        </div>
    </div>
    <div class="form-group">
        <label for="mobile" class="control-label col-xs-12 col-sm-2">{:__('手机号')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input type="text" class="form-control" id="mobile" name="row[mobile]" value="" data-rule="required" />
        </div>
    </div>
    <div class="form-group">
        <label for="group_id" class="control-label col-xs-12 col-sm-2">{:__('身份')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input type="text" class="form-control selectpage" data-source="wanlshop/separate/store_list"
                   id="group_id" data-field="group_name" name="row[group_id]"  value="{$row.group_id|htmlentities}" data-rule="required" />
        </div>
    </div>
    <div class="form-group">
        <label for="group_id" class="control-label col-xs-12 col-sm-2">{:__('区域')}:</label>
        <div class="col-xs-12 col-sm-8">
            <div class="form-inline" data-toggle="cxselect" data-selects="province,city,area">
                <select class="province form-control" name="row[province]" id="province" data-url="ajax/area">
                </select>
                <select class="city form-control" name="row[city]" id="city" data-url="ajax/area">
                </select>
                <select class="area form-control" name="row[area]" id="area" data-url="ajax/area">
                </select>
            </div>
        </div>
    </div>
    <div class="form-group">
        <label for="group_id" class="control-label col-xs-12 col-sm-2">{:__('地址')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input type="text" class="form-control" id="address" name="row[address]" data-rule="required" />
        </div>
    </div>


    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-success btn-embossed disabled">{:__('OK')}</button>
            <button type="reset" class="btn btn-default btn-embossed">{:__('Reset')}</button>
        </div>
    </div>
</form>
